Standing Up for Ourselves

As far as I can tell, there really should be no such thing as an emergency referral.

All too often during the day, my workflow is interrupted by an emergency message, flagged high priority with a little red up-arrow in our electronic health record's message in-basket, alerting me that one of my patients is in her podiatrist's office, but that they won't see her without a referral. They need it immediately.

As you are likely aware, these annoying referrals are left over from a bygone day when we used to contact our colleagues requesting that they see our patients in consultation. In those days it was a quick phone call, or passing a colleague in the hallways of the hospital. They've been hijacked, however, by the insurance industry, and somehow we have allowed ourselves to have them become our job, turned into a massive administrative burden that primary care providers need to take care of.

How did we let ourselves get to this point? How did we let the insurance company tell us that we needed to do these? Why did we not say no?

We are doing their work. Is this really providing something that can improve care, save money, or is it really just about making more money for the insurance companies?

All I know is that this is work for my office staff and for me that, if you stop and look at it, comes with very little benefit.

And more than anything else, this is emblematic of how we've let our profession get pulled off the track, railroaded by yet another special interest, with a different set of goals.

Let's face it, the insurance industry is primarily interested in making a profit, keeping their shareholders happy, no matter what their commercials say. I understand that part, I'm not faulting a business for trying to remain profitable.

In a recent article in HIT Consultant, author Margalit Gur-Arie talked about how primary care doctors leaving the inpatient world ceded much of their power by taking themselves away from the hallowed halls of hospitals where bonds form, relationships are built, and power resides.

I think this issue with referrals, and the fact that it feels like far too much of the time we're working for the insurance companies, doing their paperwork, clicking their boxes, getting their referrals filed on their online systems and faxed to referring specialist's offices, is just an example of how we have relinquished our control of our profession.

How do we make this stop?

If we are going to change the healthcare system in this country, as turned on its head as it is, we need to stand up and say that this is unacceptable, that this work is so far below "practicing up to your license" that we cannot even see our license.

We need to bring our voices back to the table and be part of negotiations with all of the major insurers, those requesting favorable rates and reimbursements for practitioners. Those deciding that it is okay for providers to do this non-healthcare work.

Isn't it time that we as a profession told them that we're not gonna take this any more, that there really is no need for these referrals to be living in the middle of the healthcare process, of our process of taking care of our patients?

The insurance industry should be able to develop a more modern system of monitoring the use of resources by their patients, beyond me checking a little box that allows a patient five visits with her podiatrist -- maybe by monitoring these things electronically through claims data, actively informing patients each time they use up one of the benefits they have remaining.

There's gotta be an app for that ...

Taking the doctors out of this process could improve our quality of life and the satisfaction of our patients. And no doubt the system's efficiency will also dramatically improve, and savings will undoubtedly follow.

Just let her see her podiatrist. What am I adding to this process?

And know that these referrals are just one symptom of all the ills that are eating away at our healthcare system, chewing away the infrastructure, making our lives and patients' lives miserable. There are countless ways we can stand up and reclaim our place at the table, re-establish our power, and start being one of the forces that shape the healthcare system in this country.